Atopic dermatitis, stinging, and effects of chronic stress: a pathocausal study

J Am Acad Dermatol. 2004 Dec;51(6):899-905. doi: 10.1016/j.jaad.2004.05.035.


Background: Patients with atopic dermatitis (AD) often have increased skin sensitivity and this symptom often worsens during stress.

Objective: We sought to find out whether patients with AD had stinging, and to identify the pathocausal neuroimmune mechanisms, including the role of stress.

Methods: In all, 25 patients with AD with histories of stress worsening were tested using a stinger test. Skin biopsy specimens were processed for immunohistochemistry. Stress inquiries and salivary cortisol tests were performed.

Results: In all, 16 patients were stinger-positive and 9 were negative. The stinger-positive papillary dermis had an increased number of mast cells, vasoactive intestinal polypeptide-positive fibers, and a tendency to a higher number of substance P-positive nerve fibers, but a decrease of calcitonin gene-related peptide fibers. Patients who were stinger-positive had a tendency to lower salivary cortisol.

Conclusions: The majority of patients with AD experience stinging. Substance P, calcitonin gene-related peptide, vasoactive intestinal polypeptide, and mast cells may have a pathocausal role, as might chronic stress.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Chronic Disease
  • Cosmetics / adverse effects
  • Dermatitis, Atopic / etiology*
  • Dermatitis, Atopic / pathology
  • Female
  • Humans
  • Hydrocortisone / analysis
  • Lactic Acid
  • Male
  • Mast Cells
  • Middle Aged
  • Neuropeptides / analysis
  • Saliva / chemistry
  • Skin / pathology
  • Skin Tests
  • Stress, Physiological / complications*


  • Cosmetics
  • Neuropeptides
  • Lactic Acid
  • Hydrocortisone